Humana Nurse Auditor 2 -- REMOTE/WORK AT HOME (ANYWHERE IN THE US/PR) in Albany, New York

Become a part of our caring community and help us put health first The Nurse Auditor 2 performs clinical audit/validation processes to ensure that medical record documentation and diagnosis coding for services rendered is complete, compliant and accurate to support optimal reimbursement. The Nurse Auditor 2 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action. The Nurse Auditor 2 validates and interprets medical documentation to ensure capture of all relevant coding. Identifies members with high risk CMS Hierarchical Condition Categories (HCC) and refers cases for annual follow-up care by disease management, case management, and primary care providers as appropriate for assessment/intervention. Identifies the root cause analysis of audit findings and submits recommendations for appropriate change management. Applies clinical and coding experience to conduct reviews of provider codes and billing. Understands department, segment, and organizational strategy and operating objectives, including their linkages to related areas. Makes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed. Follows established guidelines/procedures. Use your skills to make an impact Required Qualifications - What it takes to Succeed Minimum of Associate Degree; Active Registered Nurse license (RN) in the state/territory in which they reside Minimum of 2 years acute inpatient hospital care experience or inpatient auditing experience in the last 5 years Familiarity with MS Office (Word, Excel, etc) Excellent writing, editing, interpersonal, planning, teamwork, and communications skills Demonstrated ability to exercise solid judgment and discretion in handling and disseminating information Ability to work independently and manage work load Customer-service focused and exhibit professionalism, flexibility, dependability, desire to learn, commitment to excellence and commitment to profession HOURS: M-F, 8 hours per day/5 days per week. Work is performed between 6AM-6PM in employee's time zone (EST/CST/MST/PST). Overtime is occasionally offered, but no weekends/holidays.

Preferred Qualifications

Bachelor's Degree in relevant field preferred Inpatient coding certification (AHIMA or AAPC - ex: RHIA, RHIT, CCS, CIS, CIC) 2 years inpatient coding experience Acute inpatient hospital care experience or inpatient auditing experience in ICU, ER, Trauma or CVOR Prospective payment methodologies, auditing experience Clinical documentation improvement knowledge Additional Information - How we Value You Benefits starting day 1 of employment Competitive 401k match Generous Paid Time Off accrual Tuition Reimbursement Parent Leave Go365 perks for well-being Work at Home Requirements WAH requirements: Must have the ability to provide a high speed DSL or cable modem for a home office. Associates or contractors who live and work from home in the state of California will be provided payment for their internet expense. A minimum standard speed for optimal performance of 25x10 (25mpbs download x 10mpbs upload) is required. Satellite and Wireless Internet service is NOT allowed for this role. A dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information Interview Format As part of our hiring process, we will be using an exciting interviewing technology provided by Hire Vue/Modern Hire, a third-party vendor. This technology provides our team of recruiters and hiring managers an enhanced method for decision-making. If you are selected to move forward from your application prescreen, you will receive correspondence inviting you to participate in a pre-recorded Voice Interview and/or an SMS Text Messaging interview. If participating in a pre-recorded interview, you will respond to a set of interview questions via your phone. You should anticipate this interview to take approximately 10-15 minutes. If participating in a SMS Text interview, you will be asked a series of questions to which you will be using your cell phone or computer to answer the questions provided. Expect this type of interview to last anywhere from 5-10 minutes. Your recorded interview(s) via text and/or pre-recorded voice will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews. #ThriveTogether #WorkAtHome Scheduled Weekly Hours 40 Pay Range The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.$69,800 - $96,200 per yearThis job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual perform Apply tot his job Apply To this Job